Walking Aids and Locomotion Training in the Emergency Department: A Randomized Clinical Trial.

Importance: Mobility limitations are common in older adults and impact quality of life and social interaction. Walking aids can improve mobility and prevent falls but require oversight and training. Despite being recommended by geriatric emergency department (ED) guidelines, their effectiveness in this setting has not been studied to date. Objective: To evaluate the effectiveness of training and provision of walking aids, with or without telemonitoring, on mobility, fear of falling, gait, functional capacity, quality of life, cognition, depression, and occurrence of falls in older adults after an ED visit compared with safe ambulation recommendations only. Design, Setting, and Participants: This randomized clinical trial was conducted at the Geriatric ED of Hospital Sírio-Libanês, São Paulo, Brazil, from July 20 to December 16, 2023, with a 90-day follow-up. Participants were patients 65 years or older who were discharged from the geriatric ED with at least 1 indication for walking aids according to the institutional protocol. Researchers involved in postintervention assessment and statistical analyses were blinded to group allocation. Intervention: Seventy-five participants were allocated to 1 of 3 groups: control, walking aids (WA), or walking aids with telemonitoring (WAT). All participants received safe ambulation recommendations. Intervention groups (WA and WAT) were assessed and trained in device use by a physiotherapist. The WAT group received telemonitoring follow-up to promote adherence. Main Outcomes and Measures: The primary outcomes were improved life-space mobility as assessed by the Life Space Assessment and fear of falling as assessed by the Falls Efficacy Scale International at 90 days follow-up. Secondary outcomes included gait, functional capacity, quality of life, cognition, depression, and occurrence of falls. Results: A total of 75 older adults were enrolled (mean [SD] age, 81.3 [7.7] years; 40 [53.3%] female). At 90 days, the WA group had significant improvement in life-space mobility (mean difference [MD], 12.77; 95% CI, 1.06-24.54; P = .03), fear of falling (MD, -5.60; 95% CI, -9.06 to -2.14; P = .002), and 1-minute sit-to-stand test (MD, 8.45; 95% CI, 4.34-12.56; P = .001) compared with the control group. No significant improvements were observed in any of these outcomes in the WAT group compared with the WA group. Conclusions and Relevance: In this randomized clinical trial, training and provision of walking aids for older adults in the ED improved mobility and fear of falling as long as 90 days after discharge. The addition of telemonitoring did not result in additional benefits. This study highlights the role of a specialized physiotherapy intervention to optimize outcomes in older adults in the ED. Trial Registration: ClinicalTrials.gov Identifier: NCT05950269.